Although electrocardiographic (ECG) abnormalities and autopsy evidence of myocardial necrosis are associated with subarachnoid hemorrhage, their relation to in vivo measures of left ventricular function in this condition has not been established. Thirteen patients with subarachnoid hemorrhage and no prior history of heart disease were studied by two-dimensional echocardiography, performed initially 10 to 48 h (mean 18) after admission and serially for less than or equal to 14 days. Serum creatine kinase (total and myocardial isoenzyme) was determined 5 times over the first 48 h; ECGs were performed daily. Neurologic state was assessed with the use of a standard grading system. Four patients (Group I) exhibited left ventricular wall motion abnormalities in one to eight segments. In two of these patients there was also left ventricular apical mural thrombus that embolized in one patient, leading to further neurologic deterioration. The initial creatine kinase myocardial isoenzyme was higher in Group I than in Group II (patients without wall motion abnormalities) (10.3 versus 2.1 U/liter, p less than 0.001), initial heart rate was higher (91 versus 61 beats/min, p less than 0.01), neurologic grade was higher (2.5 to 4.5 versus 1 to 2, p less than 0.001) and inverted T waves were more common (4 of 4 versus 1 of 9). Three of the four patients in Group I died; two of the three underwent autopsy and were found to have no significant coronary artery disease. No other patients died.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1988

Doppler color-flow imaging assessment of shunt size in atrial septal defect.

Two-dimensional echocardiography and pulsed-Doppler studies have not proved to be reliable methods of assessing left-to-right shunt size in atrial septal defect. Doppler color-flow imaging displays the transatrial jet, providing a new dimension with the potential capability of quantifying left-to-right shunt size. Twenty-three patients with atrial septal defect were studied by color-flow imaging and cardiac catheterization. The defect size measured by two-dimensional echocardiography, the maximal color-flow jet width in the atrial septum, and the maximal color-flow jet area in the right atrium were correlated with cardiac catheterization-derived left-to-right shunt size. Correlation coefficients were 0.57 (p less than 0.01), 0.67 (p less than 0.001), and 0.65 (p less than 0.01), respectively. Atrial septal color-flow jet width distinguished patients with less than a 2:1 left-to-right shunt size ratio (eight patients, jet width less than 15 mm in in all) from patients with greater than a 2:1 left-to-right shunt size ratio (15 patients, jet width greater than 15 mm in all). These results indicate that Doppler color-flow imaging can distinguish left-to-right shunt size in atrial septal defect accurately enough to influence decisions with regard to subsequent patient management.

Adult↗

PubMed1988

Colour flow imaging in severe mitral and aortic regurgitation.

Several criteria have been proposed for the grading of severe aortic and mitral regurgitation by colour flow imaging. To evaluate the sensitivity of these criteria, colour flow imaging was performed in 21 patients with isolated severe mitral regurgitation and 11 patients with isolated severe aortic regurgitation prior to clinically indicated valvular surgery. In the colour flow imaging assessment of mitral regurgitation the criterion of the maximum distance of mitral regurgitant jet from mitral orifice greater than 4.5 cm was 95% sensitive (range 4.4 to 8.4 cm). Maximum ratio of mitral regurgitant jet area to left atrial area greater than 40% was 86% sensitive (range 32 to 84%) and maximum mitral regurgitant jet area greater than 6 cm2 was 100% sensitive (range 8.1 to 35.7 cm2) in the detection of severe mitral regurgitation. For aortic regurgitation, the criterion of height of regurgitant jet to height of left ventricular outflow tract greater than 65% in the parasternal long axis view was 100% sensitive (range 71 to 100%), whereas the ratio of area of regurgitant jet to area of left ventricular outflow tract greater than 60% in the short axis view was only 36% sensitive (range 8 to 74%) in the detection of severe aortic regurgitation requiring surgery. It is concluded that the most sensitive colour flow imaging criteria for severe mitral regurgitation is an absolute mitral jet area greater than 8 cm2; and for severe aortic regurgitation, ratio of height of regurgitant jet to height of left ventricular outflow tract greater than 65%.

Adult↗

PubMed1987

Right atrial myxoma presenting as Budd-Chiari syndrome.

A 25-year-old man experienced rapidly progressing Budd-Chiari syndrome. Despite extensive radiological investigations, no atrial mass could be identified. At operation, a right atrial myxoma was found that originated from the eustachian valve and prolapsed into the inferior vena cava. Following successful removal of the myxoma, the ascites and peripheral edema resolved completely. Right atrial myxoma is a rare cardiac tumor that may present with embolic, obstructive, or constitutional signs and symptoms and is a potentially curable cause of Budd-Chiari syndrome.

Acute Disease↗

PubMedDate not supplied

Identification of Chiari's network with transesophageal echocardiography.

A prominent Chiari's network may be difficult to distinguish from pathologic right atrial masses on transthoracic echocardiography. We report a 38-year-old woman who had a cerebrovascular accident. Transthoracic echocardiogram revealed an atrial septal aneurysm and a mobile right atrial mass. This mass was correctly identified as Chiari's network on the basis of the transesophageal echocardiographic findings of a broad base of attachment in the right atrium and filamentous nature of the mass. These findings were confirmed at surgery.

Adult↗

PubMedDate not supplied

Transesophageal echocardiography in the diagnosis of left atrial appendage aneurysm.

Intrapericardial left atrial appendage aneurysm is rare. We describe the transthoracic and transesophageal echocardiographic findings in a 42-year-old man with atrial arrhythmia and an abnormal left atrial appendage on chest roentgenogram. Presence of an intrapericardial left atrial appendage aneurysm was confirmed at surgery.

Adult↗

PubMedDate not supplied

Isolated thickening of one aortic cusp: preferential thickening of the noncoronary cusp.

Over a 2-year period we identified 197 patients with the previously undescribed finding of isolated thickening of one aortic cusp. The noncoronary cusp was involved most frequently in 56% (p less than 0.01), followed by the right coronary cusp in 35%, and the left coronary cusp in 9%. Isolated thickening of one aortic cusp occurs more commonly in male patients (64%) (p less than 0.01) and at an earlier age (65 years) than mitral annular calcification (70 years) (p less than 0.001).

Age Factors↗

PubMedDate not supplied

Cardiac tamponade by loculated pericardial hematoma following open heart surgery: diagnosis by transesophageal echocardiography.

Loculated pericardial hematoma following open heart surgery may cause significant hemodynamic compromise. Recognition of this entity may be delayed because of the absence of the classical signs of cardiac tamponade. A 54-year-old woman is described in whom transesophageal echocardiography allowed rapid diagnosis of right atrial compression by a pericardial hematoma, following mitral valve replacement. Transesophageal echocardiography should be considered for the detection of posterior loculated pericardial hematoma in the hypotensive cardiac surgical patient with a suboptimal transthoracic echocardiogram.

Cardiac Tamponade↗

PubMedDate not supplied

Transesophageal echocardiography: experience of a Canadian centre.

Transesophageal echocardiography (TEE) is a new application of echocardiography in which an ultrasonic transducer is positioned in the esophagus and stomach to obtain images of the heart without interference from lung and bone. It is particularly useful in the assessment of left atrial masses, atrial septal defects, mitral valve disease, valvular prostheses and aortic dissection. In the operative setting, TEE is used to detect early myocardial ischemia in patients with coronary artery disease undergoing noncardiac surgery as well as in the assessment of the results of valvular surgery. This review examines the technique of TEE, its indications and the early experience with the first 100 patients examined at the Toronto Western Hospital with this technique.

Canada↗